13-0455 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
�_e 4��
13-00000455
81407 GOLDEN POPPY WY
764-280-999-111 -300236-
PLUMBING
MEDIUM HIGH DENSITY RES
2000
Td4i 4.4 ��
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Cllass:1C27-1253 License No.: 964474
Date: t7`a Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( I I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: N
LQPERMIT
Owner:
ANGELO ARIONDO
81407 GOLDEN POPPY
LA QUINTA, CA 92253
(
Contractor:
DESERT OUTDOORS INC
78065 MAIN ST STE #
LA QUINTA, CA 92253
(760)399-9600
Lic. No.: 964474
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/11/13
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
r by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ued.
h e and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code,. for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier. NORGUARD INS Policy Number DEWC338066
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthw' ply with those provisions.
Dater Applicant:
WARNING: FAILURE T ECURE W SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this
�county
�to"enter upon the above-mentioned ur oses.
Date: x//6//3 Signature (Applic
Application Number . . . . . 13-00000455
Permit . . . .
. PLUMBING"
Additional desc .
Permit Fee . . .
. 18.00
Plan'Check Fee
4.50
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
10/08/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 3.0000
EA PLB GAS
PIPE 1-4 OUTLETS
3.00
----------------'------------------------------------------------------------
Special Notes and
Comments
PLUMBING - 204LF
OF GAS LINE ONLY.
2010
CODES
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG
STDS ADMIN (SB1473).
1.00
Fee summary
Charged Paid
Credited
Due
Permit Fee Total
18.00
00 00
18.00
Plan Check Total
4.50
.00 .00
4.50
Other Fee Total
1.00
.00 .00
1.00
Grand Total
23.50
.00 .00
23.50
LQPERA11T
W
Bin #Qty.
Of La Quints
Btdtdmg BL Safety Dit im
P.O Box 1504, -78-495 Cage Tampico
4.Qtdnu, CA 92253 -{760) 7777012
Building Permit Application and Tracking Sheet
Permit #
Gfi
LL
PmjectAddtecs: �: "k.31
Owner's Name:. 4aij p �
A P. Numbs:
Address:' Llcn
Legal Desexiption
City, ST, zvp: L C4
Contractor. Desert Outdoors
Telephone: •'
Address: 78-065 Main St. Ste. 205
ProjectDescr►ption:
city. �LAP: La Quinta; Ca. 92253�—
Telephone: 760-399-9600:
city Lie. #c
S
State Lia # : --C-53 964474
Arch, Engr., Designer: Flying Buttress
Address: - 77725*Enfield Ln. Ste. 130
�!
city, sT, zip: Palm Desert, CA. 92211
Telephone: 760-772-4411
State Lia #: 33446 M
Name of Contact Person:
Const rction Type:. Occupamr.
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
ni
# Stories # Uts:
Telephone # of Contact Person: - Estimated Valise of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACENG
PERMrFEES-
PIaaSets
Pian Geek submitted-
Item Amount
Stroctund Cabs.
Reviewed, ready for corrections
Plan Cheek Deposit. .
Trus Cafes.
Called contact Person
Pian Check Balance_
Titic U Cates.
Plans picked up
Construction "
Flood plain plan
Pians resubmitted.'.
Mechanical
Giading play
2'! Review, ready for correctionsfissue
Electrical
Sntreontactor List
Called CoutactPerson
Plumbing
Grant Deed
Plans picked up
SM.l.
H.O.A. Approval
Plans resubmitted
Grading
BV HOUSE:-
13& Review, ready for rorrecdonslissue
Developer Impact Fee
Planning Approval-
Called Contact Person
A.I.P.P. t
Pub. Wks. Appr
Date of permit issue
School Fees
`
Total Permit Fees
I.
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CONCRETE DeCIONG
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B. CLASS 200 PVL LATERAL
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